Alzheimer's Disease vs Parkinson's Disease: Cognitive vs Motor Predominance
Both are progressive neurodegenerative diseases in older adults, and late-stage symptoms overlap heavily — Parkinson's patients develop dementia, Alzheimer's patients lose motor function. Picking the wrong signature medication on the NCLEX (carbidopa-levodopa for Alzheimer's, or donepezil for Parkinson's motor symptoms) signals you can't distinguish the primary deficit.
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- ★↓ ACh in cortex/hippocampus
- Gradual decline over 8–12 years
- ★↓ Dopamine in substantia nigra
- Progresses over 10–20 years
- ★Amnesia, aphasia, apraxia, agnosia
- Earliest sign: recent memory loss
- ★Resting pill-rolling tremor, unilateral
- Bradykinesia, postural instability
- cogwheel rigidity, mask face, shuffling
- Rule out reversible causes (B12, TSH)
- Mental status exam (MMSE/MoCA)
- Clinical dx on cardinal motor signs
- Response to levodopa supports dx
- Wandering prevention, ID bracelet
- Structured, consistent environment
- Fall prevention — shuffling gait
- Rise slowly: orthostatic hypotension
- Cholinesterase inhibitors (donepezil)
- Memantine (NMDA antagonist)
- Donepezil: bradycardia
- Donepezil: give at bedtime
- Carbidopa-levodopa
- dopamine agonists
- Levodopa: dyskinesia, on-off effect
- Consistent routine
- Remove home hazards
- Simple one-step commands
- Don't quiz or correct; redirect
- Avoid high-protein meals with levodopa
- PT/exercise to maintain mobility
- Allow extra time for ADLs
- Remove home hazards
- Sudden confusion: rule out delirium
- Elopement or unsafe wandering
- Freezing of gait + falls
- Hallucinations on levodopa
- Late: immobility, total dependence
- Dysphagia, aspiration pneumonia
- 50–80% develop dementia late
- Dysphagia, aspiration pneumonia
Alzheimer's Disease
- ★↓ ACh in cortex/hippocampus
- Gradual decline over 8–12 years
Parkinson's Disease
- ★↓ Dopamine in substantia nigra
- Progresses over 10–20 years
Alzheimer's Disease
- ★Amnesia, aphasia, apraxia, agnosia
- Earliest sign: recent memory loss
Parkinson's Disease
- ★Resting pill-rolling tremor, unilateral
- Bradykinesia, postural instability
- cogwheel rigidity, mask face, shuffling
Alzheimer's Disease
- Rule out reversible causes (B12, TSH)
- Mental status exam (MMSE/MoCA)
Parkinson's Disease
- Clinical dx on cardinal motor signs
- Response to levodopa supports dx
Alzheimer's Disease
- Wandering prevention, ID bracelet
- Structured, consistent environment
Parkinson's Disease
- Fall prevention — shuffling gait
- Rise slowly: orthostatic hypotension
Alzheimer's Disease
- Cholinesterase inhibitors (donepezil)
- Memantine (NMDA antagonist)
- Donepezil: bradycardia
- Donepezil: give at bedtime
Parkinson's Disease
- Carbidopa-levodopa
- dopamine agonists
- Levodopa: dyskinesia, on-off effect
Alzheimer's Disease
- Consistent routine
- Remove home hazards
- Simple one-step commands
- Don't quiz or correct; redirect
Parkinson's Disease
- Avoid high-protein meals with levodopa
- PT/exercise to maintain mobility
- Allow extra time for ADLs
- Remove home hazards
Alzheimer's Disease
- Sudden confusion: rule out delirium
- Elopement or unsafe wandering
Parkinson's Disease
- Freezing of gait + falls
- Hallucinations on levodopa
Alzheimer's Disease
- Late: immobility, total dependence
- Dysphagia, aspiration pneumonia
Parkinson's Disease
- 50–80% develop dementia late
- Dysphagia, aspiration pneumonia
★ marks the fact that sets a column apart.
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Play full screen for XPClinical Pearl
Alzheimer's forgets first (↓ acetylcholine); Parkinson's trembles first (↓ dopamine) — onset sequence is your answer key.
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